ABSTRACT Introduction As biomedical advances improved HIV treatment, the perceptions of severity and anticipated consequences of HIV could have changed accordingly. This study investigates the current perceptions of severity and anticipated consequences of HIV infection and its association with sexual risk behaviour among HIV‐negative and never‐tested men who have sex with men (MSM) living in the Netherlands. Methods In‐depth interviews with recently diagnosed HIV‐positive MSM were used to develop a questionnaire measuring the perceived severity and anticipated consequences of HIV infection. The questionnaire was distributed online between April and July 2019. A structural equation model was constructed to explore the anticipated consequences contributing to the perceived HIV severity and to assess the association between the perceived severity and sexual risk behaviour. Results In total, 1,072 HIV‐negative and never‐tested MSM completed the questionnaire, of whom 28% reported recent sexual risk behaviour. Almost one‐quarter of participants (23%) had a low perceived HIV severity, which was associated with more prevalent sexual risk taking (β = −0.07, 95% CI = −0.12/−0.01). In this model, the perceived severity of HIV was more strongly associated with anticipated psychological consequences of HIV (β = 0.34, 95% CI = 0.24 to 0.44) and to a lesser extent with anticipated negative consequences of HIV on sex/relationships (β = 0.28, 95% CI = 0.19 to 0.38) and disclosure‐related consequences (β = 0.16, 95% CI = 0.07 to 0.26). Health‐related consequences of HIV were not significantly associated with the severity perceptions (β = 0.06, 95% CI = −0.03 to 0.14). Conclusions Anticipated negative social and psychological consequences of HIV mostly contribute to high HIV‐severity perceptions in MSM. A smaller subgroup of MSM does not perceive HIV as a serious disease, which is associated with increased sexual risk taking. Efforts to normalize living with HIV are essential but might present a challenge for HIV prevention as ...